# A client recovering from acute ischemic stroke with newly identified atrial fibrillation has CHA2DS2-VASc 5 and HAS-BLED 2. Which actions support secondary prevention? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375149&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A client recovering from acute ischemic stroke with newly identified atrial fibrillation has CHA2DS2-VASc 5 and HAS-BLED 2. Which actions support secondary prevention? Select all that apply.

1

Screen for and treat obstructive sleep apnea

2

Set BP target generally under 130/80 with lifestyle and pharmacotherapy

3

Begin high-intensity statin (atorvastatin 80 or rosuvastatin 40)

4

Continue dual antiplatelet (DAPT) indefinitely instead of anticoagulation

5

Initiate anticoagulation with a DOAC such as apixaban or rivaroxaban once acute risk window passed

## Explanation

Secondary prevention after stroke with AF: ANTICOAGULATION (DOAC preferred over warfarin in nonvalvular AF) when CHA2DS2-VASc indicates and HAS-BLED is acceptable; for cardioembolic AF stroke, anticoagulation is preferred over antiplatelet alone. Time to start depends on stroke size — small stroke 1-3 days, large 5-14 days post-event. High-intensity statin (atorvastatin 80, rosuvastatin 40) is standard. BP target generally under 130/80 with gradual lowering. OSA is a stroke risk factor — screen and treat. Indefinite DAPT alone is inferior in AF; antiplatelet plus anticoagulation increases bleeding without ischemic benefit unless specific indication (recent PCI).

## In-depth explanation

CHA2DS2-VASc components: CHF, HTN, Age 75+, DM, Stroke/TIA (2 pts), Vascular disease, Age 65-74, Sex female. HAS-BLED: HTN, Abnormal renal/liver, Stroke, Bleeding history, Labile INR, Elderly, Drugs/alcohol.

## Clinical scenario

HTN, DM, prior CAD, age 76, female. No recent bleeding. Renal function normal.

## Key concepts

- **CHA2DS2-VASc** — Stroke risk score in atrial fibrillation; guides anticoagulation decision.
- **HAS-BLED** — Bleeding risk score on anticoagulation; identifies modifiable risks rather than withholding therapy.
- **DOAC** — Direct oral anticoagulant (apixaban, rivaroxaban, dabigatran, edoxaban); preferred over warfarin in nonvalvular AF.

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